SUPERIOR COURT OF CALIFORNIA, COUNTY OF
STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME:

PETITION OF (Name of petitioner):

Defendant(s) : ......................................................
FOR CHANGE OF NAME AND GENDER

DECREE CHANGING NAME AND GENDER

CASE NUMBER:

THE PEOPLE OF THE STATE OF NEW YORK
1. The petition came regularly for hearing on (date):

TO

in Courtroom:

of the above-entitled court.

THE COURT FINDS 2. a. All notices required by law have been given. b. Each person whose name is to be changed identified in item 3 below GREETINGS: (1) is not is under the jurisdiction of the Department of Corrections, and is required to register as a sex offender under section 290 of the Penal Code. (2) is not WE COMMAND YOU, that all using CLETS/CJIS These determinations were made by business and excuses being laid aside, you and each of youclerk of the based on information provided to the attend before the Honorable at the Court court by a local law enforcement agency. c. County objections to the proposed change of at No of located name were made. Objections to theon the d. in room , proposed change of name were made by (name): day of , 20 , at o'clock in the noon, and at any recessed e. It appears to the satisfaction of the court that all the allegations in the petition are true and sufficient and that the petition should be granted. f. Other findings (if any):

,

or adjourned date, to testify and give evidence as a witness in this action on the part of the

3. The name of (present name): is changed to (new name):

Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a THE COURT ORDERS result of your failure to comply. Witness, Honorable Court in County, THE COURT FURTHER ORDERS , one of the Justices of the day of , 20

4. The gender of (new name): is changed: a. from male to female. b. from female to male.

(Attorney must sign above and type name below)

THE COURT FURTHER ORDERS 5. A new birth certificate shall be issued reflecting the changes in name and gender. Attorney(s)

for

Office and P.O. Address
Date:

Form Adopted for Mandatory Use Judicial Council of California NC-230 [New January 1, 2003]